High Rate of Recurrence Following Proximal Medial Opening Wedge Osteotomy for Correction of Moderate Hallux Valgus.

Abstract

BACKGROUND:

The proximal medial opening wedge (PMOW) osteotomy has become more popular to treat moderate to severe hallux valgus with the recent development of specifically designed, low-profile modular plates. Despite the promising results previously reported in the literature, we have noted a high incidence of recurrence in patients treated with a PMOW. The purpose of this study was to report the clinical and radiographic outcomes of an initial cohort of patients treated with a PMOW osteotomy for moderate hallux valgus.

METHODS:

We retrospectively analyzed prospectively gathered data on a cohort of 17 consecutive patients who were treated by the senior author using a PMOW osteotomy for moderate hallux valgus deformity. Average time to follow-up was 2.4 years (range, 1.0-3.5 years). The intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA) were assessed on standard weightbearing radiographs of the foot preoperatively and at all follow-up visits. The Foot and Ankle Outcome Score (FAOS) was collected on all patients preoperatively and at final follow-up.

RESULTS:

Despite demonstrating good correction of their deformity initially, 11 of the 17 patients (64.7%) had evidence of recurrence of their hallux valgus deformity at final follow-up. Patients who recurred had a greater preoperative HVA (P = .023) and DMAA (P = .049) than patients who maintained their correction. Improvement in the quality-of-life subscale of the FAOS was noted at final follow-up for all patients (P = .05). There was no significant improvement in any of the other FAOS subscales.

CONCLUSIONS:

There was a high rate of recurrence of the hallux valgus deformity in this cohort of patients. Recurrence was associated with greater preoperative deformity and an increased preoperative DMAA. The PMOW without a concomitant distal metatarsal osteotomy may be best reserved for patients with mild hallux valgus deformity without an increased DMAA.

LEVEL OF EVIDENCE:

Level IV, retrospective case series.

• Authors: Sravisht Iyer, Constantine A Demetracopoulos, Carolyn M Sofka, Scott J Ellis
• Journal: Foot & ankle international (Foot Ankle Int) Vol. 36 Issue 7 Pg. 756-63 (Jul 2015) ISSN: 1944-7876 [Electronic] United States
• PMID: 25780267 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2015.

Topics

• Adolescent
• Adult
• Aged
• Female
• Hallux Valgus (diagnostic imaging, surgery)
• Humans
• Male
• Metatarsal Bones (surgery)
• Middle Aged
• Osteotomy (methods)
• Quality of Life
• Radiography
• Range of Motion, Articular
• Recurrence
• Registries
• Retrospective Studies
• Treatment Failure
• Young Adult